Earlier and enhanced rehabilitation of mechanically ventilated patients in critical care: A feasibility randomised controlled trial

J Crit Care. 2018 Apr;44:407-412. doi: 10.1016/j.jcrc.2018.01.001. Epub 2018 Jan 4.

Abstract

Background: Systematic reviews of early rehabilitation within intensive care units have highlighted the need for robust multi-centre randomised controlled trials with longer term follow up. This trial aims to explore the feasibility of earlier and enhanced rehabilitation for patients mechanically ventilated for ≥5days and to assess the impact on possible long term outcome measures for use in a definitive trial.

Methods: Patients admitted to a large UK based intensive care unit and invasively ventilated for ≥5days were randomised to the rehabilitation intervention or standard care on a 1:1 basis, stratified by age and SOFA score. The rehabilitation intervention involved a structured programme, with progression along a functionally based mobility protocol according to set safety criteria.

Results: 103 out of 128 eligible patients were recruited into the trial, achieving an initial recruitment rate of 80%. Patients in the intervention arm mobilized significantly earlier (8days vs 10 days, p=0.035), at a more acute phase of illness (SOFA 6 vs 4, p<0.05) and reached a higher level of mobility at the point of critical care discharge (MMS 7 vs 5, p<0.01).

Conclusion: We have demonstrated the feasibility of introducing a structured programme of rehabilitation for patients admitted to critical care.

Keywords: Critical care; Exercise; ICU; Physiotherapy; Rehabilitation.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Critical Care / methods*
  • Critical Illness / rehabilitation*
  • Early Ambulation / methods*
  • Feasibility Studies
  • Female
  • Humans
  • Intensive Care Units
  • Male
  • Middle Aged
  • Physical Therapy Modalities
  • Respiration, Artificial / methods*